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Following the constitution of the consumer courts, a resident of Bangalore had filed a case seeking compensation from the civic authorities for the suffering undergone by him as a result of one such incident. He, however, could not make much headway in terms of compensation as the consumer court held that this was not a consumer dispute falling under the jurisdiction of the consumer courts. Well, recently another such case came up before the National Consumer Disputes Redressal Commission- except that here it was not the victim who was filing the complaint, but his son. And the complaint was not against any civic authority, but against an insurance company for its failure to pay the insured amount following the death of the insured person in one such gory incident. The case not only highlights the problems that citizens face vis-`E0-vis street dogs , but also how insurance companies try to clutch at any straw, any condition in the policy, to deny the legitimate claim of an insured person or his nominee. The decision of the apex consumer court in this case should help many policy holders and their nominees in similar circumstances. This case has its origin in the personal accident insurance policy for the year 2007-2008 taken by Venkata Ramana, a resident of Andhra Pradesh in January 2007. Unfortunately, tragedy struck him the very same year- in December, to be precise. While he was riding his bicycle, Ramana was chased by two vicious stray dogs, resulting in his falling down from the two-wheeler. If that was not bad enough, the dogs attacked him as he fell, resulting in his receiving very severe injuries on his thighs and scrotum. As per the doctor who testified before the court, he was taken to the hospital in a semi-conscious state. Even though he was referred to a surgeon, the doctors felt that his chances of survival were bleak as a result of the nature of the injury. And he did not survive.
This was contested by the insurance company on the same grounds, before the National Consumer Disputes Redressal Commission. While the insurer argued that the intimation was given late, thereby violating a policy condition, the nominee contended that he was not even aware of the insurance policy of his father and filed it as soon as he became aware of it and hence the delay. Concluding that the repudiation was not justified, the Commission pointed out that first and foremost, the complainant had clearly established, through medical records as well as the deposition of the doctor who attended on his father, that the death had occurred on account of the gory accident that he had suffered. Second, the delay in intimation in this case was not prejudicial to the insurance company in that it was not prevented, because of the delay, from carrying out any investigation leading to the insurance claim to satisfy itself that the accident and the loss fell within the substantive conditions of the insurance policy. The Commission also in this case drew a difference between a case of theft and an accidental death . It concluded that as per the settled law, the company had the obligation to prove that the grounds of repudiation had been based on legally sustainable evidence. And in this case it had failed to do so. Therefore, the repudiation of the claim was not sustainable.
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I
The insurance company
repudiated the son's claim for insurance on the ground that the
insurer was informed of the tragedy four months after the death, while
as per the policy terms, this had to be done within a month. The state
commission in its order dated July 14, 2011, held that the repudiation
of the claim by the insurance company was not sustainable. It
therefore directed the company to pay the complainant, the insured
amount of Rs 5 lakh and also pay costs of Rs 2000.